Optical and electrochemical methods for determining the effective area and charge density of conducting polymer modified electrodes for neural stimulation.

Neural stimulation is used in the cochlear implant, bionic eye, and deep brain stimulation, which involves implantation of an array of electrodes into a patient's brain. The current passed through the electrodes is used to provide sensory queues or reduce symptoms associated with movement disorders and increasingly for psychological and pain therapies. Poor control of electrode properties can lead to suboptimal performance; however, there are currently no standard methods to assess them, including the electrode area and charge density. Here we demonstrate optical and electrochemical methods for measuring these electrode properties and show the charge density is dependent on electrode geometry. This technique highlights that materials can have widely different charge densities but also large variation in performance. Measurement of charge density from an electroactive area may result in new materials and electrode geometries that improve patient outcomes and reduce side effects.

Correlation of the impedance and effective electrode area of doped PEDOT modified electrodes for brain-machine interfaces.

Electrode impedance is used to assess the thermal noise and signal-to-noise ratio for brain-machine interfaces. An intermediate frequency of 1 kHz is typically measured, although other frequencies may be better predictors of device performance. PEDOT-PSS, PEDOT-DBSA and PEDOT-pTs conducting polymer modified electrodes have reduced impedance at 1 kHz compared to bare metal electrodes, but have no correlation with the effective electrode area. Analytical solutions to impedance indicate that all low-intermediate frequencies can be used to compare the electrode area at a series RC circuit, typical of an ideal metal electrode in a conductive solution. More complex equivalent circuits can be used for the modified electrodes, with a simplified Randles circuit applied to PEDOT-PSS and PEDOT-pTs and a Randles circuit including a Warburg impedance element for PEDOT-DBSA at 0 V. The impedance and phase angle at low frequencies using both equivalent circuit models is dependent on the electrode area. Low frequencies may therefore provide better predictions of the thermal noise and signal-to-noise ratio at modified electrodes. The coefficient of variation of the PEDOT-pTs impedance at low frequencies was lower than the other conducting polymers, consistent with linear and steady-state electroactive area measurements. There are poor correlations between the impedance and the charge density as they are not ideal metal electrodes.

Restoration of the senses and human communication: Sustainable Development Goals 3 and 9.

PURPOSE: This invited commentary addresses the importance of the senses in human communication, outlines advances achieved with cochlear implants, and new research directions to improve neural prostheses. RESULT: In severely deaf people, cochlear implants restore speech understanding and enable children to achieve spoken language. Research in neural prostheses is advancing the restoration of hearing, vision, tactile senses, movement and the management of epilepsy. Bio-inspired stimulation strategies incorporating temporal and spatial characteristics of neural responses may deliver improved speech, vision and tactile perception using prostheses. To achieve stable long-term stimulation, chronic inflammation at the brain-electrode interface may be reduced using ROCK/Rho signalling pathway inhibitors and materials with brain-mimicking properties. CONCLUSION: This commentary paper addresses two Sustainable Development Goals: industry, innovation and infrastructure (SDG 9) and good health and well-being (SDG 3).

Biocompatibility of immobilized aligned carbon nanotubes.

In vivo host responses to an electrode-like array of aligned carbon nanotubes (ACNTs) embedded within a biopolymer sheet are reported. This biocompatibility study assesses the suitability of immobilized carbon nanotubes for bionic devices. Inflammatory responses and foreign-body histiocytic reactions are not substantially elevated when compared to negative controls following 12 weeks implantation. A fibrous capsule isolates the implanted ACNTs from the surrounding muscle tissue. Filamentous nanotube fragments are engulfed by macrophages, and globular debris is incorporated into the fibrous capsule with no further reaction. Scattered leukocytes are observed, adherent to the ACNT surface. These data indicate that there is a minimal local foreign-body response to immobilized ACNTs, that detached fragments are phagocytosed into an inert material, and that ACNTs do not attract high levels of surface fouling. Collectively, these results suggest that immobilized nanotube structures should be considered for further investigation as bionic components.

A conducting-polymer platform with biodegradable fibers for stimulation and guidance of axonal growth.

A biosynthetic platform composed of a conducting polypyrrole sheet embedded with unidirectional biodegradable polymer fibers is described (see image; scale bar = 50 µm). Such hybrid systems can promote rapid directional nerve growth for neuro-regenerative scaffolds and act as interfaces between the electronic circuitry of medical bionic devices and the nervous system.

Nerve repair: a conducting-polymer platform with biodegradable fibers for stimulation and guidance of axonal growth (adv. Mater. 43/2009).

Effective functional innervation of medical bionic devices, as well as re-innervation of target tissue in nerve and spinal cord injuries, requires a platform that can stimulate and orientate neural growth. Gordon Wallace and co-workers report on p. 4393 that conducting and nonconducting biodegradable polymers show excellent potential as suitable hybrid substrata for neural regeneration and may form the basis of electrically active conduits designed to accelerate nerve repair.

Can we prevent cochlear implant recipients from developing pneumococcal meningitis?

The restoration of hearing to persons with severely or profoundly impaired hearing by means of a cochlear implant is one of the great achievements of bionics applied to medicine. However, pneumococcal meningitis in implant recipients has received high profile public attention as a result of the US Food and Drug Administration's public health notification and recent media attention. Worldwide, 118 of the 60,000 people who received cochlear implants over the past 20 years have acquired meningitis, causing deep concern in the international medical community. This review provides answers to pediatricians, internists, and infectious diseases doctors who have patients with cochlear implants and who have questions about the safety of the cochlear implant from both the clinical and scientific research perspectives. Both clinical and laboratory research support the notion that pneumococcal meningitis is more likely in patients who receive cochlear implantation, and that the surgical insertion technique and the cochlear implant design should be nontraumatic, and that all cochlear implant recipients should be offered vaccination against Streptococcus pneumoniae.

Effects of inner ear trauma on the risk of pneumococcal meningitis.

OBJECTIVE: To examine the risk of pneumococcal meningitis in healthy rats that received a severe surgical trauma to the modiolus and osseous spiral lamina or the standard insertion technique for acute cochlear implantation. DESIGN: Interventional animal studies. SUBJECTS: Fifty-four otologically normal adult Hooded-Wistar rats. INTERVENTIONS: Fifty-four rats (18 of which received a cochleostomy alone; 18, a cochleostomy and acute cochlear implantation using standard surgical techniques; and 18, a cochleostomy followed by severe inner ear trauma) were infected 4 weeks after surgery with Streptococcus pneumoniae via 3 different routes (hematogenous, middle ear, and inner ear) to represent all potential routes of bacterial infection from the upper respiratory tract to the meninges in cochlear implant recipients with meningitis. RESULTS: Severe trauma to the osseous spiral lamina and modiolus increased the risk of pneumococcal meningitis when the bacteria were given via the middle or inner ear (Fisher exact test, P<.05). However, the risk of meningitis did not change when the bacteria were given via the hematogenous route. Acute electrode insertion did not alter the risk of subsequent pneumococcal meningitis for any route of infection. CONCLUSIONS: Severe inner ear surgical trauma to the osseous spiral lamina and modiolus can increase the risk of pneumococcal meningitis. Therefore, every effort should be made to ensure that cochlear implant design and insertion technique cause minimal trauma to the bony structures of the inner ear to reduce the risk of pneumococcal meningitis.

Assessment of the protective effect of pneumococcal vaccination in preventing meningitis after cochlear implantation.

OBJECTIVES: To examine if a 23-valent pneumococcal capsular polysaccharide vaccine (PPV23) reduces the risk of meningitis in healthy rats after cochlear implantation. DESIGN: Interventional animal study. INTERVENTIONS: Thirty-six rats (18 immunized and 18 unimmunized) received cochlear implantations and were then infected with Streptococcus pneumoniae via 3 different routes (hematogenous, middle ear, and inner ear) in numbers sufficient to induce meningitis. RESULTS: The rats with implants that received PPV23 were protected from meningitis when the bacteria were delivered via the hematogenous and middle-ear routes (Fisher exact test P<.05). However, the protective effect of the vaccine in the rats with implants was only moderate when the bacteria were inoculated directly into the inner ear. CONCLUSIONS: Our animal model clearly demonstrates that immunization can protect healthy rats with a cochlear implant from meningitis caused by a vaccine-covered serotype. This finding supports the notion that all current and future implant recipients should be vaccinated against S pneumoniae.

Threshold shift: effects of cochlear implantation on the risk of pneumococcal meningitis.

OBJECTIVES: The study goals were to examine whether cochlear implantation increases the risk of meningitis in the absence of other risk factors and to understand the pathogenesis of pneumococcal meningitis post cochlear implantation. STUDY DESIGN AND SETTING: Four weeks following surgery, 54 rats (18 of which received a cochleostomy alone, 18 of which received a cochleostomy and acute cochlear implantation using standard surgical techniques, and 18 of which received a cochlear implant) were infected with Streptococcus pneumoniae via three different routes of bacterial inoculation (middle ear, inner ear, and intraperitoneal) to represent all potential routes of bacterial infection from the upper respiratory tract to the meninges. RESULTS: The presence of a cochlear implant reduced the threshold of bacteria required to cause pneumococcal meningitis from all routes of infection in healthy animals. CONCLUSION: The presence of a cochlear implant increases the risk of pneumococcal meningitis regardless of the route of bacterial infection. SIGNIFICANCE: Early detection and treatment of pneumococcal infection such as otitis media may be required, as cochlear implantation may lead to a reduction of infectious threshold for meningitis.

Optimising the incorporation and release of a neurotrophic factor using conducting polypyrrole.

In this study, a neurotrophin delivery system based on an inherently conducting polymer (ICP) has been developed. Direct incorporation of neurotrophin-3 (NT-3) was investigated and controlled release was tested under various electrochemical conditions. The loading capacity and amount of NT-3 released from the polymer was determined using (125)I-labelled NT-3. Electrochemical stimulation of polypyrrole by pulsed voltage, pulsed current or cyclic voltammetry promoted the release of NT-3 at a greater rate than natural diffusion of NT-3. NT-3 was released from polypyrrole as an initial burst in the first 24 h followed by prolonged release over a subsequent 6 days of sampling. The amount of NT-3 incorporated into the polymer could be controlled by varying the polymerisation time, with longer growth periods incorporating more NT-3. The NT-3 release results indicated that the polymers grown for longer released a lower percentage of the incorporated NT-3 compared to the polymers grown for shorter times. Polymer-based neurotrophin delivery systems have the potential to be incorporated into future treatments for nerve injuries to prevent nerve degradation and promote nerve protection.

Protective effects of local administration of ciprofloxacin on the risk of pneumococcal meningitis after cochlear implantation.

OBJECTIVES: To determine whether ciprofloxacin retains its antimicrobial activity after storage with Healon at ambient temperature and at 37 degrees C over 5 weeks and then to establish whether the application of ciprofloxacin/Healon onto scala tympani electrode arrays reduces the risk of meningitis in implanted rats inoculated with S. pneumoniae. STUDY DESIGN: In vitro laboratory and in vivo animal studies METHODS: The antibacterial activity of three concentrations of ciprofloxacin/Healon (7.5, 75, and 750 microg/mL) was examined over 5 weeks at both ambient temperature (23 degrees C) and body temperature (37 degrees C). Thirty-six rats (18 implanted with ciprofloxacin [750 mg/mL]/Healon-coated electrode array and 18 without the coating) were infected with S. pneumoniae 4 weeks after implantation by way of three different routes of infection (hematogenous, middle ear, and inner ear) and observed for the development of meningitis. RESULTS: The antibacterial activity of ciprofloxacin/Healon was maintained over 5 weeks at both 23 degrees C and 37 degrees C. The implanted rats with the ciprofloxacin/Healon-coated electrode array were protected from meningitis when the bacteria were given by way of the hematogenous route (Fisher's exact test, P = .008) but not when the bacteria were inoculated directly into the middle or inner ear. However, the time to develop meningitis was significantly longer in rats implanted with a coated array, irrespective of the route of inoculation (P < .05, log rank test). CONCLUSION: Our animal model demonstrated that a ciprofloxacin-coated electrode array can protect healthy implanted rats from meningitis when the route of infection is hematogenous and can delay the onset of meningitis when bacteria are inoculated directly into the middle or inner ear.

Pneumococcal meningitis threshold model: A potential tool to assess infectious risk of new or existing inner ear surgical interventions.

HYPOTHESIS: A minimal threshold of Streptococcus pneumoniae is required to induce meningitis in healthy animals for intraperitoneal (hematogenous), middle ear, and inner ear inoculations, and this threshold may be altered via recent inner ear surgery. BACKGROUND: There has been an increase in the number of reported cases of cochlear implant-related pneumococcal meningitis since 2002. The pathogenesis of pneumococcal meningitis is complex and not completely understood. The bacteria can reach the central nervous system (CNS) from the upper respiratory tract mucosa via either hematogenous route or via the inner ear. The establishment of a threshold model for all potential routes of infection to the CNS in animals without cochlear implantation is an important first step to help us understand the pathogenesis of the disease in animals with cochlear implantation. METHODS: Fifty-four otologically normal adult Hooded Wistar rats (27 receiving cochleostomy and 27 controls) were inoculated with different amounts of bacterial counts via three different routes (intraperitoneal, middle ear, and inner ear). Rats were monitored during 5 days for signs of meningitis. Blood, cerebrospinal fluid, and middle ear swabs were taken for bacterial culture, and brains and cochleae were examined for signs of infection. RESULTS: The threshold of bacterial counts required to induce meningitis is lowest in rats receiving direct inner ear inoculation compared with both intraperitoneal and middle ear inoculation. There is no change in threshold between the group of rats with cochleostomy and the control (Fisher's exact test, p < 0.05). CONCLUSION: A minimal threshold of bacteria is required to induce meningitis in healthy animals and is different for three different routes of infection (intraperitoneal, middle ear, and inner ear). Cochleostomy performed 4 weeks before the inoculation did not reduce the threshold of bacteria required for meningitis in all three infectious routes. This threshold model will also serve as a valuable tool, assisting clinicians to quantitatively analyze if the presence of a cochlear implant or other CNS prostheses alter the risk of meningitis.

Pneumococcal meningitis: development of a new animal model.

HYPOTHESIS: The rat is a suitable animal to establish a model for the study of pneumococcal meningitis postcochlear implantation. BACKGROUND: There has been an increase in the number of cases of cochlear implant-related meningitis. The most common organism identified was Streptococcus pneumoniae. Whether cochlear implantation increases the risk of pneumococcal meningitis in healthy subjects without other risk factors remains to be determined. Previous animal studies do not focus on the pathogenesis and risk of pneumococcal meningitis postimplantation and are based on relatively small animal numbers, making it difficult to assess the cause-and-effect relationship. There is, therefore, a need to develop a new animal model allowing direct examination of the pathogenesis of meningitis in the presence of a cochlear implant. METHODS: Eighteen nonimplanted rats were infected with 1 x 10 and 1 x 10 colony-forming units (CFU) of a clinical isolate of S. pneumoniae via three different inoculation routes (middle ear, inner ear, and i.p.) to examine for evidence of meningitis during 24 hours. Six implanted rats were infected with the highest amount of bacteria possible for each route of inoculation (4 x 10 CFU i.p., 3 x 10 CFU middle ear, and 1 x 10 CFU inner ear) to examine for evidence of meningitis with the presence of an implant. The histological pattern of cochlear infections for each of the three different inoculating routes were examined. RESULTS: Pneumococcal meningitis was evident in all 6 implanted animals for each of the three different routes of inoculation. Once in the inner ear, bacteria were found to enter the central nervous system via either the cochlear aqueduct or canaliculi perforantes of the osseous spiral lamina, reaching the perineural and perivascular space then the internal acoustic meatus. The rate, extent, and pattern of infection within the cochleae depended on the route of inoculation. Finally, there was no evidence of pneumococcal meningitis observed in 18 nonimplanted rats inoculated at a lower concentration of S. pneumoniae when observed for 24 hours postinoculation. CONCLUSION: Meningitis in implanted rats after inoculation with a clinical isolate of S. pneumoniae is possible via all three potential routes of infection via the upper respiratory tract. The lack of meningitis observed in the 18 nonimplanted rats suggests that longer postinoculation monitoring periods are required to ensure whether or not meningitis will develop. Based on this work, we have developed a new animal model that will allow quantitative risk assessment of meningitis postcochlear implantation, and the assessment of the efficacy of potential interventional strategies in future studies.

An X-ray fluorescence microscopic analysis of the tissue surrounding the multi-channel cochlear implant electrode array.

OBJECTIVES: The aim of this study was to analyse the tissue surrounding the University of Melbourne's (UOMs) multi-channel cochlear implant electrode array and cochlear limited replacements, after long-term implantations. In particular, it aimed to identify the particulate material in the fibrous tissue capsule of the arrays implanted in 1978, 1983, and 1998, by using the Australian Synchrotron for X-ray fluorescence microscopy (XFM) to reveal the characteristic spectrum of metal, in particular platinum. This also helped to determine its format and chemical state. Tissue was retrieved following the recipient's death in 2007. METHODS: Tissue was fixed and sections taken across the UOM and Cochlear Corporation (CI-22 and CI-24) electrode tracks. These were stained with Masson's trichrome. The Australian Synchrotron enabled XFM to accurately identify platinum from its characteristic fluorescence spectrum. RESULTS: There was a fibrous tissue capsule (about 100-µm thick) and small regions of calcification around the UOM and CI-22 arrays, but a thinner capsule (40-60-µm thick) around CI-24, and a greater degree of calcification. Dark particulate matter was observed within macrophages and especially in fibrous tissue in proximity to the UOM and CI-22 arrays. This was identified as platinum using X-ray fluorescence. There was also diffusion of platinum into the tissue surrounding the UOM and CI-22 electrodes and fine particles had penetrated the spiral ligament. DISCUSSION: The larger particulate matter in the tissue around the UOM and CI-22 arrays suggested that it had flaked off in the manufacturing of the UOM electrodes. The more diffuse spread of platinum in the tissue around the UOM and CI-22 electrodes was likely due to electrolysis, probably from charge imbalance with the bipolar pulses from the UOM implant. This did not occur with the Cochlear CI-24 device. Furthermore, the widespread fine particles of platinum could have also been due to corrosion, especially from the UOM electrodes.

Netrin-1 as a guidance molecule in the postnatal rat cochlea.

During synaptogenesis a number of growth factors and peptides control the guidance of auditory neuron (spiral ganglion neuron, SGN) axons to their target cells. Furthermore, evidence suggests that these factors exert their actions at discrete times and sites during development. This study demonstrates that the guidance molecule netrin-1 is expressed in the early postnatal rat cochlea, but shows decreasing expression with increasing age. These results suggest that netrin-1 may be involved in guiding axonal growth from SGNs for the onset of innervation, but is not required for maintenance of synaptic connections.

The multi-channel cochlear implant: multi-disciplinary development of electrical stimulation of the cochlea and the resulting clinical benefit.

This multi-disciplinary research showed sound could be coded by electrical stimulation of the cochlea and peripheral auditory nervous system. But the temporal coding of frequency as seen in the experimental animal, was inadequate for the important speech frequencies. The data indicated the limitation was due in particular to deterministic firing of neurons and failure to reproduce the normal fine temporo-spatial pattern of neural responses seen with sound. However, the data also showed the need for the place coding of frequency, and this meant multi-electrodes inserted into the cochlea. Nevertheless, before this was evaluated on people we undertook biological safety studies to determine the effects of surgical trauma and electrical stimuli, and how to prevent infection. Then our research demonstrated place of stimulation had timbre and was perceived as vowels. This led to our discovery in 1978 of the formant-extraction speech code that first enabled severely-profoundly deaf people to understand running speech. This result in people who had hearing before becoming severely deaf was an outcome not previously considered possible. In 1985 it was the first multi-channel implant to be approved by the US Food and Drug Administration (FDA). It was also the fore runner of our advanced formant and fixed filter strategies When these codes were used from 1985 for those born deaf or deafened early in life we discovered there was a critical period when brain plasticity would allow speech perception and language to be developed near- normally, and this required in particular the acquisition of place coding. In 1990 this led to the first cochlear implant to be approved by the FDA for use in children. Finally, we achieved binaural hearing in 1989 with bilateral cochlear implants, followed by bimodal speech processing in 1990 with a hearing aid in one ear and implant in the other. The above research has been developed industrially, with for example 250,000 people worldwide receiving the Cochlear device in 2013, and as of December 2012 the NIH estimated that approximately 324,200 people worldwide had received this and other implants (NIH Publication No. 11-4798). This article is part of a Special Issue entitled .

Delayed neurotrophin treatment supports auditory neuron survival in deaf guinea pigs.

As key factors in the development and maintenance of the auditory system, neurotrophins can prevent auditory neuron degeneration when applied within three to five days of deafening. We tested each of the neurotrophins BDNF, NT-3, NT-4/5 and NGF for their ability to support auditory neuron survival following a two-week period of deafness in guinea pigs, when approximately 15% auditory neuron degeneration has already occurred. Although delayed, the treatment with each neurotrophin prevented further degeneration with similar efficacy.